Enrolling With Optimum HealthCare

You can join a Medicare Advantage Plan if you live in the plan service area, have Part A, B and D, and don’t have ESRD (except in special circumstances).

Your Enrollment Options

You can enroll with Optimum Healthcare in any of the following ways:

At an Information & Enrollment Seminar

During a Personal Home Appointment

Online with Optimum HealthCare

Online with Medicare

Over the Phone

New Enrollments call 1-888-286-2362

Existing Members call 1-888-286-2361

If you wish to enroll through a Seminar or Home Appointment, please call us at 1-866-245-5360 or TTY 711, Monday- Friday 8am - 8pm.

Not sure which plan best suits you?

Since everyone’s health needs are different, we offer a variety of Medicare Advantage Plans so you can choose the one that best fits you and your health needs. Visit our Plans and Products section to learn more or compare our plans using our Plan Finder Tool which shows and compares the plans available in your county. Optimum HealthCare is a Medicare HMO in FL.

Last Updated: 07/12/2018

Important Plan Information

Individuals must have both Part A and Part B to enroll.

You can be in only one Medicare Advantage Plan at a time; enrollment in this Plan will automatically end your enrollment in another Medicare health Plan or prescription drug Plan.

For MA-Only Plan, you understand that if you don’t have Medicare prescription drug coverage, or creditable prescription drug coverage (as good as Medicare’s), you may have to pay a late enrollment penalty if you enroll in Medicare prescription drug coverage in the future.

Enrollment in this Plan is generally for the entire year. Once you enroll, you may leave this Plan or make changes only at certain times of the year when an enrollment period is available (Example: October 15 – December 7 of every year), or under certain special circumstances.

The Plan serves a specific service area. If you move out of the area that the Plan serves, you need to notify the Plan so you can disenroll and find a new Plan in your new area.

Once you are a member of the Plan, you have the right to appeal Plan decisions about payment or services if you disagree. The rules you must follow to get coverage are listed in the Evidence of Coverage.

You understand that people with Medicare aren’t usually covered under Medicare while out of the country except for limited coverage near the U.S. border.

You understand that beginning on the date your coverage begins, you must get all of your health care from the Plan, except for emergency or urgently needed services or out-of-area dialysis services. Services authorized by the Plan and other services contained in your Evidence of Coverage document (also known as a member contract or subscriber agreement) will be covered. Without authorization, NEITHER MEDICARE NOR THE PLAN WILL PAY FOR THE SERVICES.

For Chronic Special Needs Plans (SNP): These Plans are available to anyone who has been diagnosed with one or more of the following disorders: Cardiovascular Disease (CVD); Chronic Heart Failure (CHF); Diabetes Mellitus; Chronic Obstructive Pulmonary Disease (COPD)

For Dual Special Needs Plans (DSNP): This Plan is available to anyone who has both medical assistance from the state and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the Plan for further details.

People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If you qualify, Medicare could pay up to seventy-five (75) percent or more for your drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or late enrollment penalty. Many people are eligible for these savings and don’t even know it. For more information about Extra Help, contact your local Social Security Office or call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778. You can also apply for extra help online at www.socialsecurity.gov/medicare/prescriptionhelp/

Rights and Responsibilities upon Disenrollment - "Disenrollment" from the Plan means ending your membership with us. Disenrollment can be voluntary (your choice) or, in limited circumstances, involuntary (not your choice). You might leave one of our Plans because you decide that you want to leave. During specified times (October 15 – December 7), you can choose to disenroll from your current Medicare Plan. Some situations require you to leave. For example, if you move out of our geographic service area, are absent from our service area for more than six consecutive months or if we no longer offer the Plan in your geographic area. Usually, to end your membership in our Plan, you simply enroll in another health Plan during one of the election periods. One exception is when you want to switch from our Plan to Original Medicare without a Medicare prescription drug Plan. In this situation, you must contact Member Services and ask to be disenrolled from our Plan. If you have any questions regarding your disenrollment please contact the Plan.

Release of Information: By joining this Medicare health Plan, you acknowledge that the Plan will release your information to Medicare and other Plans as is necessary for treatment, payment and health care operations. You also acknowledge that the Plan will release your information including your prescription drug event data to Medicare, who may release it for research and other purposes which follow all applicable Federal statutes and regulations.

Optimum HealthCare, Inc. is an HMO plan with a Medicare contract and a contract with the state Medicaid program. Enrollment in Optimum HealthCare, Inc.. depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. Beneficiaries generally must use network pharmacies to access their prescription drug benefit. You must continue to pay your Medicare Part B premium. Medicare beneficiaries may also enroll in Optimum HealthCare through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.

Depending on the services, a prior authorization or referral from your doctor may be required.

For Chronic Special Needs Plans (SNP): These plans are available to anyone with Medicare who has been diagnosed with Diabetes, Cardiovascular Disease, Chronic Heart Failure, or a qualified Chronic Lung Disorder, such as Chronic Obstructive Pulmonary Disease (COPD), Asthma, Chronic Bronchitis, Emphysema, Pulmonary Fibrosis, or Pulmonary Hypertension.

For Dual Special Needs Plans (DSNP): These plans are available to anyone who has both medical assistance from the state and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details. The Part B premium is covered for full dual members of Special Needs Plans.